Abstract
Background
Operative options for duodenal Crohn’s disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether differences exist in outcomes is unknown.
Methods
Patients with duodenal Crohn’s disease requiring operative intervention across a multi-state health system were identified. Patient and operative characteristics, short-term surgical outcomes, and the need for future endoscopic or surgical management of duodenal Crohn’s disease were analyzed.
Results
40 patients underwent bypass (n = 26), stricturoplasty (n = 8), or resection (n = 6). Median age of diagnosis of Crohn’s disease was 23.5 years, and over half of the patients had undergone prior surgery for CD. Operation type varied by the most proximal extent of duodenal involvement. Patients with proximal duodenal CD underwent bypass operations more commonly than those with mid- or distal duodenal disease (p = 0.03). Patients who underwent duodenal stricturoplasty more often required concomitant operations for other sites of small bowel or colonic CD (63%) compared to those who underwent bypass (39%) or resection (33%). No patients required subsequent surgery for duodenal CD at a median follow-up of 2.8 years, but two patients required endoscopic dilation (n = 1 after stricturoplasty, n = 1 after resection).
Conclusion
Patients who require surgery for duodenal Crohn’s disease appear to have an aggressive Crohn’s disease phenotype, represented by a younger age of diagnosis and a high rate of prior resection for Crohn’s disease. Choice of operation varied by proximal extent of duodenal Crohn’s disease.
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The data underlying this article will be shared on reasonable request to the corresponding author.
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Nicholas McKenna—(1) the conception and design of the study, acquisition of data, analysis, and interpretation of data, (2) drafting the article, and (3) final approval of the version to be submitted.
Katherine Bews—(1) acquisition of data, analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Maxwell Mirande—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Franciso Abarca Rendon—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Asya Ofshteyn—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Thomas Peponis—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Sherief Shawki—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Scott Kelley—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
Kellie Mathis—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.
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This manuscript was presented as a podium presentation in the Inflammatory Bowel Disease abstract session at the 2023 American Society of Colon and Rectal Surgeons Annual Meeting in Seattle, Washington from June 3-6, 2023.
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McKenna, N.P., Bews, K.A., Mirande, M.D. et al. Surgical management of duodenal crohn’s disease. Langenbecks Arch Surg 409, 132 (2024). https://doi.org/10.1007/s00423-024-03324-w
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DOI: https://doi.org/10.1007/s00423-024-03324-w